The present invention relates to a vertebral immobilization and extrication device and, more particularly, to such a device especially fabricated for use with emergency spinal injury patients, such as those, for example, who are victims in motor vehicle accidents.
As emergency medical care has matured in recent years, awareness has grown that proper prehospital handling of trauma patients can be of vital importance in reducing the severity of ultimate neurological deficit due to spinal column injury. Such handling prior to admission to a medical facility includes assessment of the possible trauma involved, the immobilization and stabilization of the patient in a rigid position least likely to aggravate the injuries, extrication of the patient from the accident situation, and transport to the facility. The personnel and equipment involved in said handling must be such as to provide an optimal balance between caution and expedience, if beneficial results are to be achieved.
As discussed in U.S. Pat. No. 3,889,668 the prior art and current practice involves the use of flat rigid spine boards, with securing and handling means therein, in association with other devices such as cervical collars, body harnesses, and flexible straps. Such equipment should be designed to be simple and convenient enough to be rapidly applied to the patient, in order to minimize risk, and yet to be effective in immobilizing the patient from the time of extrication until completion of x-ray diagnostic examination at the medical facility.
Significant problems in current practice relating to said flat rigid spine board often result with respect to both rapid application and effective immobilization. A typical and frequently occuring instance requiring the use of the spine board is a motor vehicle accident in which a victim is seated in a closely confined position. In this case a short spine board is preferably placed behind the victim with a minimum of movement of the head, neck, and spine. Often, however, the victim is pressed closely to the back support of the seat which commonly has contoured lateral supports, such as in deep bucket seats. In such a situation, placement of the flat board, which is usually approximately three-fourths inch in thickness, becomes difficult or impossible without moving the victim substantially away from the back support of the seat, thereby increasing the risk of significant spinal column injury and consequent neurological deficit.
Moreover, once the flat board is in place, the straps used in immobilizing the patient are fastened to the board only with some difficulty and at further risk of spinal movement because the board and its strap-receiving holes are often closely pressed into the back support of the seat. A further problem may arise because access to hand-holding means is similarly limited, making cautious and rapid extrication more difficult. The prior art has recognized this problem and has attempted to alleviate it. For example, longitudinal runners or transverse cleats, such as disclosed in U.S. Pat. No. 4,034,748, are often attached to the reverse side of the flat spine board to allow better access to strap and hand holes; however, such additional structure contributes to the effective width of the board and may compound the difficulty of proper initial placement. During extrication, the flat board presents a large surface area when slid across relatively flat material, such as seat cushions, resulting in friction and possible snagging of the board edge.
A still further problem may occur when the patient is in a supine position while fastened to the flat board. In such an immobilized position, vomiting by the patient is a particular risk, since aspiration may result. Lateral rotation of the patient is the best means of preventing aspiration; however, in the case of a heavy patient and an insufficient number of attendants, a carefully controlled rotation is made difficult because of the necessary use of the full width of the flat board as a lever arm. A still further disadvantage of the flat board is the limited surface area of contact with the back of the patient. Excessive stress may be exerted on the vertebral articulation rather than evenly distributed along the rib cage and shoulders. Because only such limited contact area is acting, in concert with said harness and strap means, to stabilize the patient, some lateral shifting of the body may occur, for example during rotation, and twisting or other distortion of the spinal column may result in further injury and discomfort to the patient.